Yubei Huang

Ambient particulate matter and lung cancer incidence and mortality: A meta-analysis of prospective studies

BACKGROUND Chronic exposure to ambient particulate matter (PM) has been suggested to be associated with an increased risk of lung cancer, but the results were inconsistent. We performed a systematic review and meta-analysis of prospective studies to assess the association between exposure to PM and the incidence and mortality of lung cancer in adults. METHODS We searched PUBMED and EMBASE databases for prospective cohort studies that evaluated the association between PM2.5 (diameter < 2.5 μm), PM10 (diameter < 10 μm) and lung cancer incidence and mortality. Relative risks (RRs) and 95% confidence interval (CI) were calculated using fixed-effect or random-effects models when appropriate. RESULTS We initially identified 1987 citations, and 19 prospective cohort studies were finally included in our meta-analysis. The pooled adjusted RRs for lung cancer mortality were 1.09 (95% CI: 1.06-1.11; I(2) = 18.3%, P = 0.26) for 10 µg/m(3) increase in the concentration of PM2.5 (12 studies), and 1.05 (95% CI: 1.03-1.07; I(2) = 41.9%, P = 0.11) for 10 µg/m(3) increase in the concentration of PM10 (seven studies). The increased risk of lung cancer mortality associated with PM2.5 and PM10 was consistent across most subgroups. PM10 (three studies) and PM2.5 (two studies) were not found to be significantly associated with lung cancer incidence. CONCLUSIONS Ambient PM2.5 and PM10 pollutions are prospectively associated with a significantly increased risk of lung cancer mortality. More studies addressing the association between PM and lung cancer incidence are required.

Distribution of mammographic density and its influential factors among Chinese women

BACKGROUND Mammographic density (MD) has not been systematically investigated among Chinese women. Breast cancer screening programmes provided detailed information on MD in a large number of asymptomatic women. METHODS In the Multi-modality Independent Screening Trial (MIST), we estimated the association between MD and its influential factors using logistic regression, adjusting for age, body mass index (BMI) and study area. Differences between Chinese and other ethnic groups with respect to MD were also explored with adjustment for age and BMI. RESULTS A total of 28 388 women aged 45 to 65 years, who had been screened by mammography, were enrolled in the study. Of these, 49.2% were categorized as having dense breasts (BI-RADS density 3 and 4) and 50.8% as fatty breasts (BI-RADS density 1 and 2). Postmenopausal status [odds ratio (OR) = 0.66; 95% confidence interval (CI): 0.62-0.70] and higher number of live births (OR = 0.56; 95% CI: 0.46-0.68) were inversely associated with MD, whereas prior benign breast disease (OR = 1.48; 95% CI: 1.40-1.56) and later age at first birth (OR = 1.17; 95% CI: 1.08-1.27) were positively associated with MD. In comparison with the data from the Breast Cancer Surveillance Consortium, we found that women in MIST were more likely to have fatty breasts than Americans (from the Breast Cancer Surveillance Consortium) in the older age group (≥50 years) but more likely to have dense breasts in the younger age group (<50 years). CONCLUSIONS This study suggests that several risk factors for breast cancer were associated with breast density in Chinese women. Information on the determinants of mammographic density may provide valuable insights into breast cancer aetiology.

Sleep duration and obesity in children: A systematic review and meta-analysis of prospective cohort studies

Childhood obesity is a major public problem worldwide, and sleep duration may be associated with childhood obesity. We conducted a systematic review and meta‐analysis of prospective cohort studies to estimate the associations between sleep duration and obesity/body mass index (BMI) in children.

MicroRNA-21 as a potential diagnostic biomarker for breast cancer patients: a pooled analysis of individual studies

MicroRNA-21 (miR-21) has been reported as the potential novel diagnostic biomarker for breast cancer in several studies, but their results were inconsistent. Therefore, we conducted a systematic analysis to evaluate the diagnostic value of miR-21 in detecting breast cancer. A comprehensive electronic and manual search was conducted for relevant literatures through several databases up to November 9, 2015. QUADAS-2 was used to assess the quality of the studies included in the study. All statistical analyses were performed using Meta-Disc 1.4 and Stata 12.0. Eleven studies with a total of 918 breast cancer patients and 613 controls were included. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with their 95% confidence intervals (CIs) were 0.72 (95% CI: 0.69–0.75), 0.80 (95% CI: 0.77–0.83), 3.37 (95% CI: 2.24–5.07), 0.30 (95% CI: 0.19–0.50), and 11.79 (95% CI: 5.23–26.57), respectively. The area under the curve of SROC was 0.8517. In conclusion, our analyses suggested that miR-21 is a promising biomarker in diagnosing breast cancer. For clinical purpose, further large-scale studies are warranted to validate its clinical application.

Urban-rural disparity of overweight/obesity distribution and its potential trend with breast cancer among Chinese women

Objective To evaluate the urban-rural disparity of overweight/obesity and explore its potential trend with breast cancer among Chinese women. Results The prevalence of overweight/obesity for Chinese rural women (35.2%, 29.2% for overweight and 6.0% for obesity) was significantly higher than that for Chinese urban women (33.4%, 27.7% for overweight and 5.7% for obesity) (P < 0.001). For either rural or urban women, the prevalence of overweight/obesity was highest in north region, followed by east region for rural women and north-east region for urban women. For rural women, higher prevalence of overweight/obesity was significantly positively associated with elder age, Han nationality, low level of education, no occupation, high family income, less number of family residents, insurance, and elder age at marriage. Similar positive associations were also found for urban women, except negative associations for high family income, less number of family residents, and elder age at marriage. A non-significant positive trend between overweight/obesity and breast cancer was found for rural women [odds ratio (OR): 1.06; 95% confidence interval (CI): 0.87–1.29], but a significant positive trend for urban women (OR: 1.55; 95% CI: 1.19–2.02). Materials and Methods A total of 1 210 762 participants were recruited from the Chinese National Breast Cancer Screening Program. Overweight and obesity were defined as body mass index (BMI) ranged 24.0–27.9 kg/m2 and BMI ≥ 28.0kg/m2, respectively. Conclusions There was an obvious urban-rural disparity of overweight/obesity distribution among Chinese women, which could also lead to an obvious disparity of breast cancer distribution.

Preliminary effectiveness of breast cancer screening among 1.22 million Chinese females and different cancer patterns between urban and rural women

To determine the preliminary effectiveness of breast cancer screening among Chinese females, 1226714 women aged 35–69 years first received clinical breast examinations. Urban women with suspected cancer received mammography followed by breast ultrasound (BUS), while rural suspected women underwent BUS followed by mammography. After one-year follow-up, 223 and 431 breast cancers were detected among urban and rural women (respectively), with overall detection rates of 0.56/1000 and 0.52/1000. Higher detection rates were significantly associated with older age at screening for both urban and rural women; additionally, urban women were at significantly higher risk if they had no job, no insurance, or were obese; additional risk factors specific to rural women included Han nationality, higher income, being unmarried, and having a family history of cancer (all P values < 0.05). Among screening-detected breast cancers in urban vs. rural women, 46.2% and 38.8% (respectively) were early stage, 62.5% and 66.3% were ≤2 centimeters, 38.0% and 47.3% included lymph-node involvement, and 14.0% and 6.0% were identified as carcinoma in situ. All abovementioned cancer characteristics were significantly better than clinic-detected cancers (all P values < 0.001). In conclusion, several important differences were found between urban and rural women in screening effectiveness and patterns of cancer distribution.

A survey of overall life satisfaction and its association with breast diseases in Chinese women

To investigate the association between overall life satisfaction and healthy lifestyle, knowledge of breast cancer, physical examination, and detection rate of breast cancer and benign breast disease in Chinese women. In a multicentered breast disease screening program in China, we enrolled 33,057 women aged 45–65 years without prior diagnosis of breast cancer. After completing an epidemiological questionnaire, all participants were examined by clinical breast examination, breast ultrasound, and mammography independently. All breast cancer cases and a selected sample of benign breast diseases were confirmed pathologically. Univariate and multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the association between life satisfaction and lifestyle, knowledge of breast cancer, physical examination, and detection rate of breast diseases. Overall life satisfaction was positively associated with womens healthy lifestyle. Compared with less satisfied women, satisfied women were less likely to be smokers (OR = 0.54; 95% CI: 0.47–0.62), have more exercise (OR = 1.49; 95% CI: 1.26–1.75), eat less fried (OR = 0.60; 95% CI: 0.50–0.71), smoked (OR = 0.54, 95% CI: 0.47–0.63), pickled (OR = 0.66, 95% CI: 0.55–0.79), and grilled (OR = 0.63, 95% CI: 0.54–0.74) foods. Satisfied women were more likely to have knowledge of breast cancer (OR = 1.48, 95% CI: 1.29–1.70), and have regular physical examinations (OR = 1.11, 95% CI: 1.01–1.12). Compared to less satisfied women, we found significantly lower detection rate of benign breast diseases (OR = 0.90, 95% CI: 0.82–0.99), and lower but nonsignificant detection rate of breast cancer (OR = 0.66, 95% CI: 0.35–1.25) in satisfied women. Women with a higher overall life satisfaction are more likely to have healthy lifestyle, knowledge of breast cancer, and regular physical examination, thus resulting in a lower detection rate of breast diseases in screening.

DNA methylation signatures and coagulation factors in the peripheral blood leucocytes of epithelial ovarian cancer

Solid tumors are increasingly recognized as a systemic disease that is manifested by changes in DNA, RNA, proteins and metabolites in the blood. Whereas many studies have reported gene mutation events in the circulation, few studies have focused on epigenetic DNA methylation markers. To identify DNA methylation biomarkers in peripheral blood for ovarian cancer, we performed a two-stage epigenome-wide association study. In the discovery stage, we measured genome wide DNA methylation for 485 000 CpG sites in peripheral blood in 24 epithelial ovarian cancer (EOC) cases and 24 age-matched healthy controls. We selected 96 significantly differentially methylated CpG sites for validation using Illuminas Custom VeraCode methylation assay in 206 EOC cases and 205 controls and 46 CpG sites validated in the independent replication samples. A set of 6 of these 46 CpG sites was found by the receiver operating characteristic analysis to have a prediction accuracy of 77.3% for all EOC (95% confidence interval: 72.9-81.8%). Pathway analysis of the genes associated with the 46 CpG sites revealed an enrichment of immune system process genes, including LYST (cg16962115, FDR = 1.24E-04), CADM1 (cg21933078, FDR = 1.22E-02) and NFATC1 (cg06784563, FDR = 1.46E-02). Furthermore, DNA methylation status in peripheral blood was correlated with platelet parameters/coagulation factor levels. This study discovered a panel of epigenetic liquid biopsy markers closely associated with overall immunologic conditions and platelet parameters/coagulation systems of the patients for detection of all stages and subtypes of EOC.

Assessment of performance of the Gail model for predicting breast cancer risk: A systematic review and meta-analysis with trial sequential analysis

BackgroundThe Gail model has been widely used and validated with conflicting results. The current study aims to evaluate the performance of different versions of the Gail model by means of systematic review and meta-analysis with trial sequential analysis (TSA).MethodsThree systematic review and meta-analyses were conducted. Pooled expected-to-observed (E/O) ratio and pooled area under the curve (AUC) were calculated using the DerSimonian and Laird random-effects model. Pooled sensitivity, specificity and diagnostic odds ratio were evaluated by bivariate mixed-effects model. TSA was also conducted to determine whether the evidence was sufficient and conclusive.ResultsGail model 1 accurately predicted breast cancer risk in American women (pooled E/O = 1.03; 95% CI 0.76–1.40). The pooled E/O ratios of Caucasian-American Gail model 2 in American, European and Asian women were 0.98 (95% CI 0.91–1.06), 1.07 (95% CI 0.66–1.74) and 2.29 (95% CI 1.95–2.68), respectively. Additionally, Asian-American Gail model 2 overestimated the risk for Asian women about two times (pooled E/O = 1.82; 95% CI 1.31–2.51). TSA showed that evidence in Asian women was sufficient; nonetheless, the results in American and European women need further verification.The pooled AUCs for Gail model 1 in American and European women and Asian females were 0.55 (95% CI 0.53–0.56) and 0.75 (95% CI 0.63–0.88), respectively, and the pooled AUCs of Caucasian-American Gail model 2 for American, Asian and European females were 0.61 (95% CI 0.59–0.63), 0.55 (95% CI 0.52–0.58) and 0.58 (95% CI 0.55–0.62), respectively.The pooled sensitivity, specificity and diagnostic odds ratio of Gail model 1 were 0.63 (95% CI 0.27–0.89), 0.91 (95% CI 0.87–0.94) and 17.38 (95% CI 2.66–113.70), respectively, and the corresponding indexes of Gail model 2 were 0.35 (95% CI 0.17–0.59), 0.86 (95% CI 0.76–0.92) and 3.38 (95% CI 1.40–8.17), respectively.ConclusionsThe Gail model was more accurate in predicting the incidence of breast cancer in American and European females, while far less useful for individual-level risk prediction. Moreover, the Gail model may overestimate the risk in Asian women and the results were further validated by TSA, which is an addition to the three previous systematic review and meta-analyses.Trial registrationPROSPERO CRD42016047215.

Improved Performance of Adjunctive Ultrasonography After Mammography Screening for Breast Cancer Among Chinese Females

Micro‐Abstract This is the first study to investigate whether women other than those with dense breasts are suitable for adjunctive ultrasonography after negative mammography, and also the first study to determine whether all women with negative mammography are suitable for adjunctive ultrasonography. Introduction: Until now, no studies have investigated whether women other than those with dense breasts are suitable for adjunctive ultrasonography after negative mammography, and investigated whether all women with negative mammography are suitable for adjunctive ultrasonography. Methods: Based on the Multi‐modality Independent Screening Trial in China, a total of 31,918 women aged 45 to 65 years underwent both ultrasonography and mammography. Physicians performed ultrasonography and mammography separately and were blinded to each others findings until their interpretations had been recorded. For both ultrasonography and mammography, suspicious results and those highly suggestive of a malignancy were confirmed by pathologic examination, whereas other results were confirmed by 1‐year follow‐up after initial screening. Results: Based on Breast Imaging Reporting and Data System (BIRADS) assessments, 84 (84.8%) of 99 cancers were identified on mammography (detection rate, 2.6/1000), and 61 (61.6%) of 99 cancers were identified on ultrasonography (detection rate, 1.9/1000). Integrated mammography with ultrasonography identified 94 (95.0%) of 99 cancers, with an increment of 11.9% in cancer detection rate (from 2.6/1000 to 2.9/1000) (P < .05). Moreover, among women with BIRADS 3, adjunctive ultrasonography detected no cancers. All 10 additional cancers detected by adjunctive ultrasonography were from women with BIRADS 0 to 2, at a cost of 207 women with false positives. Additionally, dense breasts and benign breast disease were significantly associated with positive ultrasonography after BIRADS 0 to 2 (all P values < .05). Conclusions: After negative mammography, adjunctive ultrasonography should only be recommended for BIRADS 0 to 2 but not BIRADS 3, especially for women with dense breasts or benign breast disease.